NPIMap

Organization Active NPI

N & R of Springfield Montclair LLC

Doing business as Springfield Villa

  • Skilled Nursing Facility
  • Springfield, MO
National Provider Identifier
1619401676
Registry record updated Sep 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
043573 Issued in MO
Legal business name
N & R OF SPRINGFIELD MONTCLAIR LLC
Doing business as
Springfield Villa
Practice address
1100 E Montclair St
Springfield, MO 65807-5076
Phone
(417) 820-8500
Fax
(417) 820-8503
NPI assigned
Apr 17, 2017
Last updated
Sep 16, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Carla Hedrick, CFO
Title
Cfo
Phone
(573) 481-9625

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 043573 MO Primary

Addresses

Primary practice location

1100 E Montclair St
Springfield, MO 65807-5076

Mailing address

1100 E Montclair St
Springfield, MO 65807-5076
Phone (417) 820-8500

Other identifiers 1

IdentifierTypeStateIssuer
107807604MedicaidMO

Other names 1

  • Springfield Villa Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL 199.119.81.30:8291 Other eSolutions Inc

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170811000798 MO Part A Provider - Skilled Nursing Facility 1355612151 Practice locations: Springfield, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1619401676. Details of each certification follow.

Skilled nursing facility certification: CCN 265814

Legal name
N & R OF SPRINGFIELD MONTCLAIR, LLC
Doing business as
SPRINGFIELD VILLA
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jun 1, 2007
Last certification
Nov 21, 2023
Beds
146
Ownership / control type
Limited Liability Corporation
Most recent change of ownership
May 1, 2017
Organization structure
LLCProprietary
Incorporated
May 1, 2017 in MO
Enrollment address
1100 E Montclair St
Springfield, MO 65807-5076
Nursing home name
SPRINGFIELD VILLA
Affiliated entity
JAMES & JUDY LINCOLN

Care Compare: Nursing home

Medicare Care Compare
Listed as
Springfield VillaCCN 265814 · All quality measures
Overall star rating
1 of 5
Health inspections
1 of 5
Staffing
1 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Jun 1, 2007
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
146118.4 residents per day on average
Chain
James & Judy Lincoln56 facilities in the chain
Penalties (3 years)
1Fines totaling $69,595

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
26D0924565N & R of Springfield Montclair LLC1100 East Montclair, Springfield, MO 65807Certificate of waiverFeb 2, 2027

National Provider Directory

National Provider Directory

Locations

1100 E Montclair St
Springfield, MO 65807
Phone (417) 820-8500

Ownership & related parties

All disclosed owners & managing parties 4

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Jaquelyne a Spence Individual W-2 Managing EmployeeAdministrator Jul 1, 2017 100%
LTC Management Services LLC Organization, Sikeston, MO Management services company Operational/Managerial Control May 1, 2017 100%
James C Lincoln Individual 5% Or Greater Direct Ownership Interest May 1, 2017 50%
Judy L Lincoln Individual 5% Or Greater Direct Ownership Interest May 1, 2017 50%

Facilities with the same owner 36

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 36

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1492387200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757980800000",
    "number": "1619401676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 E MONTCLAIR ST",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658075076",
            "telephone_number": "417-820-8500",
            "fax_number": "417-820-8503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 E MONTCLAIR ST",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658075076",
            "telephone_number": "417-820-8500",
            "fax_number": "417-820-8503"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "N & R OF SPRINGFIELD MONTCLAIR LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-17",
        "last_updated": "2025-09-16",
        "certification_date": "2025-09-16",
        "status": "A",
        "authorized_official_last_name": "HEDRICK",
        "authorized_official_first_name": "CARLA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "573-481-9625",
        "authorized_official_credential": "CFO"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MO",
            "license": "043573",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "107807604",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "199.119.81.30:8291",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1066.1",
            "affiliationName": "eSolutions Inc",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CSV",
            "address_1": "8215 w 108th ter",
            "city": "overland park",
            "state": "KS",
            "country_code": "US",
            "postal_code": "662101661",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Springfield Villa",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Springfield, MO

Sources for this page

Verify at the official NPI Registry.